2. Although several life-supporting systems of the body are involved in the pathophysiologic characteristics of shock, shock itself results from failure of which system?
a. Circulatory
b. Endocrine
c. Neurologic
d. Respiratory
ANS: A
When the heart fails as a pump, the lack of tissue perfusion follows and deprives all the bodys cells of oxygen and the removal of wastes.

3. A nurse is assessing a patient who is in shock. What should the nurse be aware that one common sign will be, regardless of the cause of the shock?
a. The skin is cool and dry with cyanotic nail beds.
b. The skin is cool and moist with cyanotic nail beds.
c. The nail beds are reddened, and the skin is moist and warm.
d. The nail beds are reddened, and the skin is dry and warm.
ANS: B
Venous blood pools in the extremities of the fingers as a result of the lack of adequate perfusion of tissues, which makes the skin cool and moist from a lack of oxygen and waste exchanges.

5. What should a nurse expect of a patients respirations caused by the falling blood pressure and impaired blood circulation during the refractory stage of shock?
a. Rapid and deep
b. Rapid and shallow
c. Slow and deep
d. Slow and shallow
ANS: D
During the refractory stage of shock, as the body systems are failing, the respirations become slow, shallow, and irregular. Death is imminent at this stage.

6. A licensed practical/vocational nurse (LPN/LVN) is assisting in developing a nursing care plan for a patient in shock. Which nursing diagnosis should be included?
a. Increased cardiac output, related to hypertension
b. Increased cardiac output, related to hypotension
c. Decreased cardiac output, related to hypovolemia
d. Decreased cardiac output, related to hypertension
ANS: C
Decreased amount of blood is ejected from the heart because of a decreased volume of fluid in the intravascular compartment.

9. A nurse is caring for a patient who has a cervical spine injury and assesses progressive hypotension. What does this signify?
a. Anaphylaxis
b. Respiratory alkalosis
c. Multiple organ dysfunction syndrome (MODS)
d. Neurogenic shock
ANS: D
Gradually decreasing blood pressure in a person with a spinal injury is an indicator of neurogenic shock related to the parasympathetic stimulation, which causes generalized vasodilation.

10. While shopping in the mall, a nurse sees a lady suddenly fall to the floor. On immediate assessment, the nurse realizes she is not in cardiac arrest and has no need for cardiopulmonary resuscitation (CPR). What should be the immediate actions by the nurse?
a. Check the pulse and respirations and call for a blood pressure cuff.
b. Check the pulse, respirations, skin color, and temperature.
c. Call for help and check the pulse, respiration, and mental status.
d. Ask someone to help place large blankets or coats under her legs and trunk.
ANS: C
Shock treatment requires expert medical implementation. However, the nurse may provide first-line support until such help arrives. Circulatory collapse has to be monitored first; pulse, respiration, and mental status should be assessed to evaluate whether oxygen is reaching the brain.

11. A nurse is explaining the rationale behind the use of Hypothermic devices to a patients family. When relaying information what explanation should the nurse provide when asked why this garment provides compression to the legs and abdomen?
a. To help restore cellular perfusion
b. Decreases internal hemorrhage
c. Cools the patient to create less metabolic demand
d. Applies pressure during the systole phase and relax pressure during the diastole phase
ANS: A
Hypothermic devices compress the vessels in the legs and abdomen to increase both blood pressure and cardiac output.

12. A nurse is speaking to the family of a 65-year-old Latino woman. To whom should the nurse address most of the conversation to keeping in mind cultural considerations?
a. 66-year-old husband
b. Entire family, in general
c. 42-year-old daughter (oldest child)
d. 40-year-old son (only son)
ANS: A
Many older Latino families recognize the older men in the family, the father or husband, as the decision makers.

13. In treating a person outside of a medical facility, a nurse knows that immediate circulatory support for the vital organs must begin as quickly as possible because, without oxygen, the brain cells will begin to die in how many minutes?
a. 4
b. 6
c. 14
d. 24
ANS: A
Brain cells must have oxygen to live; they are very sensitive to lack of oxygen and begin to die in 4 minutes.

15. What causes the cool, damp skin of patients in compensatory shock?
a. Constriction of peripheral blood vessels because of the shunting of blood to the vital organs
b. Action of the antidiuretic hormone released in shock by the adrenal glands
c. Decreasing levels of arterial carbon dioxide, which are pooling in the arms and legs
d. Activation of the baroreceptors in the renal arteries
ANS: A
When overall blood volume is reduced in shock, the remaining blood volume is shunted to vital organs.

16. Which position enhances cerebral blood flow to counteract the symptoms of compensatory shock?
a. Fowler
b. Trendelenburg
c. Gravity neutral
d. Side lying
ANS: B
The Trendelenburg position, with the patients head down, allows gravity to pull blood to the cerebrum. All other positions are ineffective for improving cerebral perfusion.

18. Which nursing interventions will best assist a patient cope with decreased cardiac output?
a. Dovetailing nursing care tasks allows rest periods for the patient.
b. Maintaining enough cover prevents the patient from shivering.
c. Turning, coughing, deep breathing, and ambulating the patient every 2 hours reduce the risk of embolism.
d. Analgesics should be administered cautiously.
ANS: A
Care should be designed to reduce the metabolic demands on the failing heart. Shivering and physical activity increase the demands; analgesics may reduce output more.

19. One of the most important assessments that a nurse makes is to check urine output. Which value objectively validates minimal acceptable renal perfusion for the average-size person?
a. 0.5 mL/kg/hr
b. 0.5 mL/lb/hr
c. 1 mL/lb/hr
d. 0.2 mL/kg/hr
ANS: A
When the kidneys produce at least 0.5 mL/kg/hr of urine, the indication is that the vital organs are also being perfused.

20. A patient is in the compensatory stage of shock. What symptoms displayed by the patient would indicate the need to implement immediate nursing action?
a. Irritable and restless
b. Listless and confused
c. Unconscious
d. Anxious and fearful
ANS: A
An irritable and restless patient is at definite risk for falling or hurting him- or herself.

22. A family member asks why her father, who is being treated for cardiogenic shock, needs parenteral feeding because he is capable of eating small amounts. What is the best response by the nurse?
a. Parenteral feedings reduce the risk of constipation.
b. Parenteral feedings meet the patients hypermetabolic needs.
c. Parenteral feedings are more convenient and less time consuming.
d. Parenteral feedings decrease the hazard of infection.
ANS: B
Hyperbolic nutritional needs of the person in shock are best met by parenteral feedings, which guarantee adequate calories.

23. A patients family voices concern regarding the purpose of some of the interventions for systemic inflammatory response syndrome (SIRS). What explanation by the nurse is most appropriate when explaining the rationale of treatment?
a. Applying a MAST garment is mandatory to promote and conserve body heat.
b. Inserting an IABP is required to decrease fluid leaking into the extravascular space.
c. Maintaining strict isolation is vital to prevent an overlying bacterial infection.
d. Aggressive treatment is necessary to support the multiple failing organs.
ANS: D
SIRS is the final and possibly fatal stage of shock. The bodys defenses are supported aggressively and rapidly. MAST and IABP are measures used to increase circulating volume. Isolation is not indicated.

24. An older Japanese patient in progressive shock lingers on the verge of death. What intervention does the patients cultural background dictate?
a. Allow any and all cultural rituals at the bedside.
b. Encourage the family to talk to the patient who can be comforted by their familiar voices.
c. Restrict the ministrations of the folk healer.
d. Suggest that small children not see the patient.
ANS: B
Japanese cultural behavior for the dying patient advocates that the entire family be in attendance and take part in the nursing care.